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Association of prematurity with complications and failure to rescue in neonatal surgery

  • Steven C. Mehl
    Correspondence
    Corresponding author at: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States.
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • Jorge I. Portuondo
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States
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  • Rowland W. Pettit
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States
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  • Sara C. Fallon
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • David E. Wesson
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • Sohail R. Shah
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • Adam M. Vogel
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • Monica E. Lopez
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, MS390, Houston, TX 77030, United States

    Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
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  • Nader N. Massarweh
    Affiliations
    Atlanta VA Health Care System, Decatur, GA, United States

    Department of Surgery, Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, United States

    Department of Surgery, Morehouse School of Medicine, Atlanta, GA, United States
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Published:November 06, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.10.050

      Highlights

      • There is an inverse dose-dependent relationship between FTR and gestational age.
      • The dose-dependent relationship was consistent for both low- and high-risk procedures.
      • A lone infection point for FTR was identified at 31-32 weeks with cubic spline analysis.

      Abstract

      Background

      The majority of failure to rescue (FTR), or death after a postoperative complication, in pediatric surgery occurs among infants and neonates. The purpose of this study is to evaluate the association between gestational age (GA) and FTR in infants and neonates.

      Methods

      National cohort study of 46,452 patients < 1 year old within the National Surgical Quality Improvement Program–Pediatric database who underwent inpatient surgery. Patients were categorized as preterm neonates, term neonates, or infants. Neonates were stratified based on GA. Surgical procedures were classified as low- (< 1% mortality) or high-risk (≥ 1%). Multivariable logistic regression and cubic splines were used to evaluate the association between GA and FTR.

      Results

      Preterm neonates had the highest FTR (28%) rates. Among neonates, FTR increased with decreasing GA (≥ 37 weeks, 12%; 33–36 weeks, 15%; 29–32 weeks, 30%; 25–28 weeks 41%; ≤ 24 weeks, 57%). For both low- and high-risk procedures, FTR significantly (trend test, p < 0.01) increased with decreasing GA. When stratifying preterm neonates by GA, all GAs ≤ 28 weeks were associated with significantly higher odds of FTR for low- (OR 2.47, 95% CI [1.38–4.41]) and high-risk (OR 2.27, 95% CI [1.33–3.87]) procedures. A lone inflection point for FTR was identified at 31–32 weeks with cubic spline analysis.

      Conclusions

      The dose-dependent relationship between decreasing GA and FTR as well as the FTR inflection point noted at GA 31–32 weeks can be used by stakeholders in designing quality improvement initiatives and directing perioperative care.

      Level of evidence

      Level IV, Retrospective cohort study

      Keywords

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